Declaring COVID-19 deaths at the district level will avoid a lot of the present confusions, says Kerala’s Death Audit Committee member Dr Aravind Reghukumar. At present declarations happen at state level and due to certain technicalities, this leads to a number of pending cases where the status of a person being coronavirus positive remains unclear.
For many months now, there has been a controversy over the reporting of COVID-19 deaths in the state. There have been accusations that the state was underreporting deaths due to COVID-19. At present, there are daily declarations of deaths happening at state-level, from the data consolidated from districts. The death declaration committee, however, is different from the death audit committee. The former gives the data you get in the daily reports of COVID-19. The declaration committee works on the basis of certain technicalities involving an identity number used for identifying COVID-19 cases. The DAC, on the other hand, is a scientific community that has to study the causes for deaths and prevent them; it is not one for declaring deaths.
“The committee has existed for long and it is not for COVID-19 studies alone. However in recent months the focus has been on COVID-19,” Dr Aravind says. The monthly reports of the DAC study the total number of deaths due to communicable or infectious diseases (including COVID-19 and others). It then classifies which are the COVID-19 deaths. If it excludes a certain death reported as COVID-19 by a treating doctor, it mentions the reason for doing so. The reverse happens too, when a non-COVID death reported by a hospital is categorised as COVID-19 after studying the case.
After the audit, the number of COVID-19 deaths is usually more than those declared in the respective month. For instance, in March 2021, the number of deaths reported by the state’s dashboard was 424. However, the audit report has given the COVID-19 deaths as 701 out of the 766 deaths it studied. “But this needn’t pertain just to the month of March. There can be pending cases from previous months too,” Dr Aravind says.
Dr Aravind says that the confusions over declaring deaths mainly arise out of the centralised system now. The declarations need to happen at the district level. This is because a patient is identified as COVID-19 based on an identity number created at the time of test. This data can sometimes be missing due to various reasons which can easily be rectified at the district level.
“For every person who tests positive, an SRF-ID is created. This refers to Specimen Referral Form. The IDs are maintained in the Lab Data Management System (LDMS) portal. When it reaches the committee for declaration (of COVID-19 deaths), they check for the SRF-ID. If it is not there, they keep it as a pending case. This can happen in several situations. For example, if a person who tested positive is sent from one hospital to another, the second hospital won’t test again and there will not be a record of the SRF-ID. When the bulletin goes out, there will be no SRF-ID. The declaration committee needs this ID, but we at the DAC do not,” says Dr Aravind.
Dr Aravind says that the Kerala government has agreed to the new plan of declaring the deaths at district level. This will also ensure transparency since it will be online, he says.
However the DAC too is not able to audit all deaths in a month since they may not receive all the details of a case. These would again remain as pending cases until further details are received. In the March report, there were 29 pending cases.
A question that can arise is why declare everyday instead of waiting for the audit report so there will not be confusion. However, the declarations are necessary to ensure that people who die after getting COVID-19 are cremated or buried following all protocols. “A COVID-19 patient who died by suicide would still be infectious and the body has to follow all protocol, even though the cause of death will not be marked as COVID-19 (suicides are one of the circumstances allowed by the World Health Organisation in excluding COVID-19 as cause of death),” Dr Aravind says.
The disparity in the number of bodies that followed COVID-19 protocol and the number of deaths reported as COVID-19 also created confusion.“Hopefully all this will be clear when it is made district-wise declarations and online,” he adds.